Sucralfate NSAIDs

For treatment of NSAID-induced ulcers, nonselective NSAIDs should be discontinued (when possible) if an active ulcer is confirmed. Most uncomplicated NSAID-induced ulcers heal with standard regimens of an H2RA, PPI, or sucralfate (see Table 29-2) if the NSAID is discontinued. If the NSAID must be continued, consideration should be given to reducing the... 

Drugs that affect NSAIDs include the following Bisphosphonates, cholestyramine, cimetidine, colestipol, cyclosporine, diflunisal, DMSO, fluconazole, ketoconazole, phenobarbital, phenylbutazone, probenecid, rifampin, ritonavir, salicylates, sucralfate. 

Gastrointestinal. Patients taking continuous steroid, especially in combination with a nonsteroidal antiinflammatory drug (NSAID), have an excess incidence of peptic ulcer and haemorrhage of about 1-2%. It is plainly unreasonable to seek to protect all such patients by routine prophylactic antiulcer therapy, i.e. to treat 98 patients unnecessarily in order to help two. But such therapy (proton pump inhibitor, histamine H -receptor blocker, sucralfate) is appropriate when ulcer is particularly likely, e.g. a patient with rheumatoid arthritis taking an NSAID, or for patients with a history of peptic ulcer disease. There is increased incidence of pancreatitis. 

Clinically important, potentially hazardous interactions with aminophylline, amiodarone, antacids, antineoplastics, arsenic, bepridil, bismuth, bismuth subsalicylate, bretylium, calcium salts, cocoa, didanosine, disopyramide, duloxetine, erythromycin, iron, magnesium salts, meptazinol, methylxanthines, NSAIDs, phenothiazines, procainamide, quinidine, rasagiline, sotalol, sucralfate, tizanidine, tricyclic antidepressants, zinc... 

Continuous antiulcer therapy (see Table 33-9) is aimed at the long-term maintenance of ulcer heahng and at preventing ulcer-related complications. Because HP eradication dramatically decreases ulcer recurrence (<10% at 1 year), continuous maintenance therapy has become largely obsolete. However, maintenance therapy may be indicated for patients who have a history of ulcer-related complications, a healed refractory ulcer, failed HP eradication therapy, or who are heavy smokers or NSAID users. Long-term maintenance therapy with an H2RA, PPI, or sucralfate is safe, but sucralfate should be avoided in renal impairment. 

Single dose studies do not necessarily reliably predict what will happen when patients take drugs regularly, but most of the evidence available suggests that sucralfate is unlikely to have an adverse effect on treatment with these NSAIDs. 

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